Organization
PACIFIC UNIVERSITY
Active
Other names
Pacific University Mobile EyeVan
Organization subpart
No
Provider details
NPI number
Authorized official
LISA DOWNING (COMPLIANCE OFFICER)
(503) 352-2663
Entity
Organization
Contact information
Practice address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1797
(503) 352-2020
(503) 352-2046
Mailing address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1797
(503) 352-2020
(503) 352-2046
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WP0200X
Pediatric Optometrist
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500778799
—
OR
Enumeration date
08/28/2019
Last updated
11/14/2023
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